Unless otherwise indicated herein, the approaches described in this section are not prior art to the claims in this application and are not admitted to be prior art by inclusion in this section.
Various systems and methods exist to provide radiation therapy treatment of tumorous tissue with high-energy radiation. Many forms of radiation treatment benefit from the ability to accurately control the amount, location, and distribution of radiation within a patient's body. Such control often includes using a multi-leaf collimator to shape a radiation beam to approximate that of the tumorous region.
Many existing radiation treatment procedures require a location of a target region to be determined in order to accurately register the target region relative to a radiation source before radiation is applied to the target region. Computed tomography (“CT”) is an imaging technique that has been widely used in the medical field. In a procedure for CT, an x-ray source and a detector apparatus are positioned on opposite sides of a portion of a patient under examination. The x-ray source generates and directs an x-ray beam towards the patient, while the detector apparatus measures the x-ray absorption at a plurality of transmission paths defined by the x-ray beam during the process. The detector apparatus produces a voltage proportional to the intensity of incident x-rays, and the voltage is read and digitized for subsequent processing in a computer. By taking a plurality of readings from multiple angles around the patient, relatively massive amounts of data are thus accumulated. The accumulated data are then analyzed and processed for reconstruction of a matrix (visual or otherwise), which constitutes a depiction of a density function of a volume of the bodily region being examined. Cone-bream computed tomography imaging (CBCT) which uses a flat panel detector is typically used in radiation therapy systems.
CT has found its principal application in examination of bodily structures or the like which are in a relatively stationary condition. In some cases, it may be desirable to continuously monitor a position of a target region while a treatment procedure is being performed. However, currently available apparatus that supports CT may not be able to generate tomographic images with sufficient quality or accuracy in part due to intra-fraction motion caused by inadvertent patient shifts or natural physiological processes. For example, breathing or expelling gas through the rectum has each been shown to cause degradation of quality in CT images. In such cases, it would be desirable to track a movement of the target region to ensure that a treatment radiation beam is accurately aimed towards the target region. In existing radiation treatment systems, tracking of the target region does not use a CT imaging technique. This is because collecting a sufficient quantity of CT image data for image reconstruction may take a long time, and therefore may not be performed at a fast enough rate to provide sufficiently current information to adjust the treatment radiation beam.
Another approach to 3D localization is “3D point tracking” which relies on taking individual projection radiographs and localizing high density implanted fiducial markers in each projection, for example by using the pixel coordinates of the markers' centroids. Then triangulation is performed to find the 3D position of a marker by using different radiographs taken at different projection angles. However, finding the pixel coordinates of a high density marker in a single X-ray projection can be difficult. Overlaying anatomy and external structures are an important source of failure of these techniques. Very often, the X-ray quantum noise and scattered radiation result in the failure to detect or localize a marker using automatic image analysis algorithms.
Conventional portal imaging techniques use treatment “beam's-eye view” (“BEV”) imaging to track both inter- and intra-fraction motion. One drawback is that most BEV imaging occurs at MV energies, which is less dose-efficient than imaging at kilo-volt (kV) energies. Another drawback is that, if high density fiducial markers are used, the markers may not be exposed to BEV at all times, thus causing treatment to be interrupted for purposes of repositioning the multi-leaf collimator blades. Interruption of treatment is particularly undesirable for arc-therapies.
Some radiation therapy treatment systems are equipped with kV imaging systems mounted to the gantry whose projection angle is orthogonal to the treatment beam. The imaging techniques used with such an orthogonal system also can include CT imaging and 3D point tracking. An advantage of the kV system is its higher dose efficiency. Moreover, the imaging target can be exposed at all times during treatment since the kV source is only used for imaging. Nevertheless, the motion-related problems with full CT acquisitions still exist as can SNR and other limitations associated with acquiring a single projection radiograph for 3D point tracking.